scholarly journals Endovascular treatment of intracranial ‘blister’ and dissecting aneurysms

2019 ◽  
Vol 32 (5) ◽  
pp. 353-365 ◽  
Author(s):  
Marius G Kaschner ◽  
Bastian Kraus ◽  
Athanasios Petridis ◽  
Bernd Turowski
Keyword(s):  
Endovascular Treatment ◽  
Favourable Outcome ◽  
Modified Rankin Scale ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Parent Vessel Occlusion ◽  
Aneurysm Occlusion ◽  
Vessel Reconstruction ◽  
Dissecting Aneurysms

IntroductionBlister and dissecting aneurysms may have a different pathological background but they are commonly defined by instability of the vessel wall and bear a high risk of fatal rupture and rerupture. Lack of aneurysm sack makes treatment challenging.PurposeThe purpose of this study was to assess the safety and feasibility of endovascular treatment of intracranial blister and dissecting aneurysms.MethodsWe retrospectively analysed all patients with ruptured and unruptured blister and dissecting aneurysms treated endovascularly between 2004–2018. Procedural details, complications, morbidity/mortality, clinical favourable outcome (modified Rankin Scale ≤2) and aneurysm occlusion rates were assessed.ResultsThirty-four patients with endovascular treatment of 35 aneurysms (26 dissecting aneurysms and 9 blister aneurysms) were included. Five aneurysms were treated by parent vessel occlusion, and 30 aneurysms were treated by vessel reconstruction using stent monotherapy ( n = 9), stent-assisted coiling ( n = 7), flow diverting stents ( n = 13) and coiling + Onyx embolization ( n = 1). No aneurysm rebleeding and no procedure-related major complications or deaths occurred. There were five deaths in consequence of initial subarachnoid haemorrhage. Complete occlusion (79.2%) was detected in 19/24 aneurysms available for angiographic follow-up, and aneurysm recurrence in 2/24 (8.3%). The modified Rankin Scale ≤2 rate at mean follow-up of 15.1 months was 64.7%.ConclusionTreatment of blister and dissecting aneurysms developed from coil embolization to flow diversion with multiple stents to the usage of flow diverting stents. Results using modern flow diverting stents encourage us to effectively treat this aneurysm entity endovascularly by vessel reconstruction. Therefore, we recommend preference of vessel reconstructive techniques to parent vessel occlusion.

Endovascular Treatment of Distally Located Giant Aneurysms

Neurosurgery ◽  
2000 ◽  
Vol 47 (5) ◽  
pp. 1147-1153 ◽  
Author(s):  
Ian B. Ross ◽  
Alain Weill ◽  
Michel Piotin ◽  
Jacques Moret
Keyword(s):  
Endovascular Treatment ◽  
Treated Patient ◽  
Collateral Flow ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Selective Embolization ◽  
Giant Aneurysms ◽  
Aneurysm Embolization ◽  
Parent Vessel Occlusion

Abstract OBJECTIVE Because giant aneurysms (GAs) can be technically difficult to clip, the endovascular approach is becoming increasingly popular. Endovascular treatment of distally located GAs, which often requires parent vessel occlusion, is particularly challenging because limited pathways are available for collateral flow. We aimed to determine the outcomes of endovascular attempts to treat GAs downstream from the circle of Willis. METHODS Between 1991 and 1998, 27 patients with 27 distally located very large aneurysms or GAs were evaluated for possible endovascular treatment. Ten underwent selective embolization and 9 were treated with primary parent vessel occlusion, with or without distal bypass. Eight patients could not be treated endovascularly. RESULTS Selective embolization resulted in only one cure. Two patients died as a result of subarachnoid hemorrhage during the follow-up period. One coil-treated patient, who underwent subsequent spontaneous parent vessel occlusion, and all nine patients treated primarily with parent vessel occlusion were considered cured after their treatments. Only two patients treated with parent vessel occlusion experienced periprocedural ischemia, which did not result in a major deficit in either case. Of the eight patients who could not be treated endovascularly, one succumbed to surgery, four died while being treated conservatively, and three were lost to follow-up monitoring. CONCLUSION Selective aneurysm embolization is usually not curative in these situations. For selected patients, however, endovascular parent vessel occlusion is usually safe and effective in preventing the progression of symptoms and bleeding.

The ARTISSE intrasaccular device for intracranial aneurysm treatment: short-term, mid-term and long-term clinical and angiographic results

2021 ◽  
pp. neurintsurg-2021-017806
Author(s):  
Michel Piotin ◽  
Robert Fahed ◽  
Hocine Redjem ◽  
Stanislas Smajda ◽  
Jean Philippe Desilles ◽  
...  
Keyword(s):  
Hemorrhagic Stroke ◽  
New Paradigm ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Parent Vessel Occlusion ◽  
Aneurysm Occlusion ◽  
Permanent Neurological Deficit ◽  
Major Stroke

BackgroundThe concept of intra-aneurysmal flow disruption has emerged as a new paradigm for the treatment of primarily bifurcation aneurysms. The purpose of this study was to determine the clinical and angiographic outcomes of patients treated with the new ARTISSE intrasaccular device (ISD).MethodsSelected patients with bifurcation aneurysms that matched the indications of the ARTISSE ISD defined by the manufacturer were treated in a single center. Clinical and angiographic follow-up was conducted at 6 and 36 months. Aneurysm occlusion was assessed using the Raymond–Roy classification scale.ResultsNine subjects with nine unruptured bifurcation aneurysms were enrolled. Mean aneurysm size was 7.2±1.2 mm (range 5.5–9.7 mm). An adequate aneurysm occlusion (defined as a complete occlusion or a neck remnant) was achieved in 6/9 patients (66.7%) at 6 months and 4/7 patients (57.1%) at 36 months follow-up. Two of the nine subjects experienced a major stroke (22.2%), including one on postoperative day 1 due to a procedure-related parent vessel occlusion and subsequent ischemic stroke. The other major stroke occurred within the 36-month follow-up period during treatment of a separate aneurysm with coils, leading to perforation with hemorrhagic stroke causing a permanent neurological deficit.ConclusionThe ARTISSE ISD was successfully deployed in all nine cases. There were, however, several procedure-related complications and results in terms of angiographic aneurysm occlusion were modest.

Parent vessel occlusion for P2 dissecting aneurysms of the posterior cerebral artery

2009 ◽  
Vol 71 (3) ◽  
pp. 319-325 ◽  
Author(s):  
Xianli Lv ◽  
Youxiang Li ◽  
Chuhan Jiang ◽  
Xinjian Yang ◽  
Zhongxue Wu
Keyword(s):  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Parent Vessel Occlusion ◽  
Dissecting Aneurysms

Parent vessel occlusion after Pipeline embolization of cerebral aneurysms of the anterior circulation

2017 ◽  
Vol 127 (6) ◽  
pp. 1333-1341 ◽  
Author(s):  
Matthew B. Potts ◽  
Maksim Shapiro ◽  
Daniel W. Zumofen ◽  
Eytan Raz ◽  
Erez Nossek ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Parent Artery ◽  
Parent Vessel ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Complex Aneurysms ◽  
Aneurysm Size ◽  
Parent Vessel Occlusion ◽  
Anterior Circulation Aneurysms

OBJECTIVEThe Pipeline Embolization Device (PED) is now a well-established option for the treatment of giant or complex aneurysms, especially those arising from the anterior circulation. Considering the purpose of such treatment is to maintain patency of the parent vessel, postembolization occlusion of the parent artery can be regarded as an untoward outcome. Antiplatelet therapy in the posttreatment period is therefore required to minimize such events. Here, the authors present a series of patients with anterior circulation aneurysms treated with the PED who subsequently experienced parent vessel occlusion (PVO).METHODSThe authors performed a retrospective review of all anterior circulation aneurysms consecutively treated at a single institution with the PED through 2014, identifying those with PVO on follow-up imaging. Aneurysm size and location, number of PEDs used, and follow-up digital subtraction angiography results were recorded. When available, pre- and postembolization platelet function testing results were also recorded.RESULTSAmong 256 patients with anterior circulation aneurysms treated with the PED, the authors identified 8 who developed PVO after embolization. The mean aneurysm size in this cohort was 22.3 mm, and the number of PEDs used per case ranged from 2 to 10. Six patients were found to have asymptomatic PVO discovered incidentally on routine follow-up imaging between 6 months and 3 years postembolization, 3 of whom had documented “delayed” PVO with prior postembolization angiograms confirming aneurysm occlusion and a patent parent vessel at an earlier time. Two additional patients experienced symptomatic PVO, one of which was associated with early discontinuation of antiplatelet therapy.CONCLUSIONSIn this large series of anterior circulation aneurysms, the authors report a low incidence of symptomatic PVO, complicating premature discontinuation of postembolization antiplatelet or anticoagulation therapy. Beyond the subacute period, asymptomatic PVO was more common, particularly among complex fusiform or very large–necked aneurysms, highlighting an important phenomenon with the use of PED for the treatment of anterior circulation aneurysms, and suggesting that extended periods of antiplatelet coverage may be required in select complex aneurysms.

scholarly journals Stent Treatment of Arterial Dissection

2005 ◽  
Vol 18 (2_suppl) ◽  
pp. 49-52
Author(s):  
J. Berkefeld
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Arteries ◽  
Arterial Dissection ◽  
Antithrombotic Drugs ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Initial Event ◽  
Stent Treatment ◽  
Parent Vessel Occlusion ◽  
Dissecting Aneurysms

Dissections of cerebral arteries are most often treated in a conservative manner with the use of antithrombotic drugs. This is justified by the relatively benign cause of the disease after the initial event. However, there are some exceptions from this rule: Stent treatment of stenotic dissections should be considered in patients who are hemodynamically compromised or recurrently symptomatic. Dissecting pseudoaneurysms must be treated after subarachnoid hemorrhage or in traumatic cases. Parent vessel occlusion is still the best option in this condition. Coiling with soft coils or stenting + coiling may be an alternative in cases without sufficient collaterals or in unruptured dissecting aneurysms.

scholarly journals Endovascular Treatment of Ruptured Dissecting Posterior Inferior Cerebellar Artery Aneurysms

2012 ◽  
Vol 18 (4) ◽  
pp. 442-448 ◽  
Author(s):  
I. Ioannidis ◽  
N. Nasis ◽  
A. Andreou
Keyword(s):  
Endovascular Treatment ◽  
Medical Center ◽  
Posterior Inferior Cerebellar Artery ◽  
Vascular Anatomy ◽  
Parent Artery ◽  
Parent Vessel ◽  
Cerebellar Artery ◽  
Clinical Records ◽  
Dissecting Aneurysms

Dissecting aneurysms of the posterior inferior cerebellar artery (PICA) distal to its origin from vertebral artery (VA) are very rare. Although rare, they associated with a high risk of rebleeding and they present a therapeutic challenge. This study reviewed the clinical presentations, angiographic characteristics of dissecting aneurysms of the PICA and to assess the clinical and angiographic outcomes of patients who underwent endovascular treatment. Ten patients with ten dissecting aneurysms who underwent endovascular treatment were identified in the clinical records of a single medical center from January 2000 to December 2010. The mean follow-up duration was 2.8 years. All patients presented with subarachnoid hemorrhage (SAH). They all underwent endovascular treatment, which included occlusion of the dissected segment and the parent artery after detailed angiographic evaluation of the vascular anatomy, and test occlusion of the PICA. In all patients the endovascular treatment was successfully completed without procedure related complications. Long-term follow-up studies in seven out of ten patients showed complete occlusion of the aneurysm with no new neurologic deficits. The clinical outcome was good in eight cases, whereas two patients with poor clinical condition at admission died during their initial hospital stay. Endovascular occlusion of the parent vessel and the dissected segment is relatively safe treatment option for dissecting aneurysms of the PICA distal to its origin.

scholarly journals Endovascular Management for P2 Aneurysms of the Posterior Cerebral Artery

2009 ◽  
Vol 15 (3) ◽  
pp. 341-348 ◽  
Author(s):  
X. Lv ◽  
Y. Li ◽  
C. Jiang ◽  
Z. Wu
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Effective Treatment ◽  
Posterior Cerebral Artery ◽  
Parent Artery ◽  
Endovascular Management ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Presenting Symptoms ◽  
Parent Vessel Occlusion

This study evaluated the outcomes of endovascular management for P2-segment aneurysms. From 2003 to 2008, 14 consecutive patients with P2 aneurysms were treated endovascularly by proximal P2 segment occlusion at our institution. The aneurysms included 12 P2a and two P2p aneurysms. Presenting symptoms were caused by subarachnoid hemorrhage (SAH) in six patients, stroke in five, and isolated headaches in three. Mean follow-up was 14 months. Twelve aneurysms were treated with proximal P2 segment occlusion without parent artery revascularization. Twelve aneurysms were at the P2a and two aneurysms at the P2p. Two patients developed hemianopsia after the procedure and one recovered completely within six months follow-up with one still persistent at 22-month follow-up. Proximal parent vessel occlusion was a relatively safe, effective treatment for P2 aneurysms that posed low risk for early or delayed ischemia or infarction.

scholarly journals Treatment of Giant Intracranial Aneurysms

2009 ◽  
Vol 15 (2) ◽  
pp. 135-144 ◽  
Author(s):  
X. Lv ◽  
C. Jiang ◽  
Y. Li ◽  
X. Yang ◽  
J. Zhang ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Covered Stent ◽  
Parent Artery ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Selective Embolization ◽  
Giant Intracranial Aneurysms ◽  
Parent Artery Occlusion ◽  
Parent Vessel Occlusion

We report on report the clinical outcome obtained in treatment of giant intracranial aneurysms (GAs). Between 2005 and 2007, 51 patients with 51 GAs presented at our hospital. Twenty-nine were treated with primary parent vessel occlusion without distal bypass and ten underwent treatment preserving the parent artery. Twelve patients could not be treated endovascularly. Selective embolization (including two remodeling techniques and two stent-coil embolizations) resulted in only one cure. Two patients died as a result of subarachnoid hemorrhage periprocedurely. Twenty-nine patients treated primarily with parent vessel occlusion and three patients treated with covered stent were considered cured after their treatments. Only one patient treated with parent vessel occlusion experienced ischemia during follow-up, which resulted in a mild neurological deficit. Of the twelve patients who could not be treated endovascularly, one succumbed to surgery, four died while being treated conservatively, and three were lost to follow-up. Parent artery occlusion, covered stent and coil occlusion provide effective protection against bleeding. In treatment of paraclinoid GAs of the internal carotid artery, the use of a stent, and stent-assisted coil embolization may be a pitfall.

The Guglielmi Detachable Coil “Crescent” in the Endovascular Treatment of Peripheral Brain Aneurysms: Technical Case Report

2007 ◽  
Vol 61 (suppl_5) ◽  
pp. ONSE295-ONSE296
Author(s):  
Guido Guglielmi ◽  
Fernando Vinuela ◽  
Giulio Guidetti ◽  
Mauro Dazzi
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Arteries ◽  
Parent Artery ◽  
Parent Vessel ◽  
Detachable Coil ◽  
Vessel Occlusion ◽  
Guglielmi Detachable Coil ◽  
Limited Experience ◽  
Parent Vessel Occlusion ◽  
Brain Aneurysms

Abstract Objective: Peripheral brain aneurysms arise from the distal segments of cerebral arteries. They can be treated by surgery or by an endovascular approach. We present our experience of endovascular treatment of peripheral brain aneurysms with a novel endovascular device, the Guglielmi detachable coil (GDC) “crescent.” Methods: The GDC “crescent” is a 5-mm long, curved coil steerable beyond the tip of a microcatheter and detachable at a distance. The GDC “crescent” was used in three cases of intracranial peripheral aneurysms to occlude their parent vessel. Results: Three peripheral brain aneurysms in three patients were successfully treated with parent vessel occlusion using the prototype GDC “crescent” coils, thereby excluding the aneurysms from the brain circulation. No complications were encountered. Conclusion: From this limited experience, the GDC “crescent” seems particularly suitable for the controlled endovascular occlusion of the often-narrow parent artery of distal brain aneurysms.

Sign in / Sign up

Export Citation Format

Share Document